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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197801162
Report Date: 06/20/2024
Date Signed: 06/20/2024 02:01:58 PM

Document Has Been Signed on 06/20/2024 02:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:INDEPENDENT OPTIONS, INC./ADVANCED OPTIONS, S.G.FACILITY NUMBER:
197801162
ADMINISTRATOR/
DIRECTOR:		IRMA SWENSONFACILITY TYPE:
775
ADDRESS:603 W. COVINA BLVD.TELEPHONE:
(909) 394-3300
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY: 30CENSUS: 27DATE:
06/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Irma Swenson- Program DirectorTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA Maldonado met with Program Director (PD), Irma Swenson, and explained the purpose for the visit.

During today's visit, LPA Maldonado conducted a tour of the physical plant with PD, reviewed (5) client files, and (5) staff files. The facility is a single story building, operating as an Adult Day Program. It is licensed to serve (30) Developmentally Disabled adults, ages 18-65. There is a fire clearance approved for (20) non-ambulatory clients, of which (6) may use wheelchairs and (4) may use walkers only. Hours of operation M-F 7AM to 5PM. An approved mitigation plan is in place and Infection Control plan has been submitted to the department for review.

LPA observed activity rooms to be clean and free of hazards. Bathrooms were observed to have the required grab bars and were free from odors. The hot water was tested and measured at 114*F, which is in compliance. Clients provide their own lunch and snacks. The facility does not store client medications and/or assist with medication administration. The facility does not store or assist clients with Personal and Incidental funds. Sufficient staff were observed to provide care and supervision to the clients in care at all times. Fire extinguishers were observed throughout, with current inspections and were fully charged. All sharps and cleaning supplies/toxins were observed to be locked and inaccessible to clients in care. The last emergency disaster drill was conducted on 01/05/24 and last fire drill was conducted on 04/06/24. Smoke/Carbon monoxide detectors were observed in every room and operational. No bodies of water were observed on the premises. Emergency food and water supplies were observed and readily available. LPA reviewed (5) client files and discovered that Client#4 (C4) has an admission agreement on file, but is not completed and signed by C4, as required. It was also discovered that Client#5 (C5) does not have an admission agreement or a current IPP on file. (5) staff files were reviewed and observed to be complete with all required documentation. Staff files were observed to have proof of current CPR/CPI/AED certification.

Deficiencies were observed during today's visit and will be cited on the LIC809-D page.
An exit interview was conducted and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Valeria Maldonado
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/20/2024 02:01 PM - It Cannot Be Edited


Created By: Valeria Maldonado On 06/20/2024 at 01:49 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: INDEPENDENT OPTIONS, INC./ADVANCED OPTIONS, S.G.
FACILITY NUMBER: 197801162

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82068(a)
Admission Agreements
(a) The licensee shall complete and maintain an individual written admission agreement with each client and the client's authorized representative, if any.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in admissions agreement for C4 not signed by the client and no available admissions agreement for C5, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2024
Plan of Correction
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Program Director will obtain a completed and signed Admissions Agreement for C4-C5 by POC due date.
Type B
Section Cited
CCR
82068.2(d)(1)
Needs and Services Plan
(d) If the client has an existing needs appraisal or individual program plan (IPP) completed by a placement agency, or a consultant for the placement agency, the Department may consider the plan to meet the requirements of this section provided that: (1) The needs appraisal or IPP is not more than one year old.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in C5's current IPP/Needs and Services Plan not on file, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2024
Plan of Correction
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Program Director will obtain current IPP/Needs and Services Plan for C5 by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Fernando Fierros
LICENSING EVALUATOR NAME:Valeria Maldonado
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2024


LIC809 (FAS) - (06/04)
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